Features And Advantages Of MEDICARE ADVANTAGE PLANS

When it comes to Medicare plans, there are two basic types of them; one category is of original plans, whereas the other category comprises of advantage plans. There are basically three types of advantage plans:

·         Private fee for service plans (PFFS)

·         Preferred provider organization plans (PPO)

·         Health maintenance organization plans (HMO)

These advantage plans, as mentioned by different insurance agents in Lombard, are just like the original plans which comprised of Part A and B, the only difference is that one can get all the benefits covering original plans through a private insurance company and that there are some added benefits too like dental and eye care coverage along with coverage for prescription drugs.

There are many features of these advantage plans that will be discussed in brief below.

Private fee for service (PFFS) plan

In this plan, the major difference is that the insurance company holds the reign regarding how much will be paid to the medical service provider and how much will be paid by the beneficiary for the covered medical service. Under PFFS plan, one will have to reach those services which, under the Medicare contract, will accept PFFS payment terms.

Features of PFFS plans

·         There will be no need for referrals to see any specialist.

·         One will not have to choose any primary care physician.

·         One will have to find the providers who accept PFFS payment terms; also, any non-network facility can choose to change their policy and refuse the PFFS payment terms.

·         One should always ask and check if is visiting any non-network medical service provider.

·         One will have to pay the Part B premium along with a separate premium for advantage plan.

Advantages of PFFS plans

·         They have a greater network as compared to other advantage plans like HMO and PPO.

·         One can ask for an advance coverage decision if one is not sure whether a certain service is covered or not.

·         One can go out to the provider network, all one needs to see is that the Medicare-approved provider accepts the terms or not.

·         One can add the prescription drug coverage, Part D plan to the PFFS plan, as one cannot do the same to HMO or PPO PLANS.

HMO and PPO plans

These two are one of the famous Medicare advantage plans who need to visit the doctor frequently. Also under these plans, the provider will accept the approved amount by the Medicare, and there can be no balance billing under these plans.

Features of HMO

·         One will have to go to the doctors who are the network only, and if see a doctor is outside the network, then the plan’s costs will go higher.

·         There will be a need for a referral if one wants to see any specialist.

·         There will be a primary care doctor.

Features of PPO

·         There is a network of doctors, and if going out of the network, then the costs will be higher.

·         There will be no primary care doctor.

·         There will be no need for a referral for seeing any specialists.

Advantages of HMO and PPO

·         These plans are better for those who need frequent medical attention.

·         These plans are always accepted by the provider who has a Medicare contract even if they do not fall in the network.

·         HMO and PPO have a prescription drug plan included in it.